60 year old caucasian female with two week history of decreased vision in the left eye. Background history includes multiple sclerosis for which she uses Gileyna for the past five years, and no history of uveitis or recent MS relapse. Her vision in the left eye was 20/100 J5. The eye appeared overall "quiet" with the exception of rare cells in the anterior vitreous. The fundus appearance and FA can be seen in the images provided. STK was administered and neurologist was able to discontinue the Gileyna. 10 days later the CME had decreased significantly. 8 weeks later the edema had resolved as seen in the OCT images of the initial and latest appearance.
-
Fingolimob Associated Macular Edema (FAME)?
Jun 1 2019 by John S. King, MD
60 year old Caucasian female with two week history of decreased vision in the left eye. Background history includes multiple sclerosis for which she uses Gilenya for the past five years, and no history of uveitis or recent MS relapse. Her vision in the left eye was 20/100 J5. The eye appeared overall "quiet" with the exception of rare cells in the anterior vitreous. The fundus appearance and FA can be seen in the images provided. The fundus image shows a blunt foveal reflex , and a few mid-peripheral IRHs, OS only. Retinal hemorrhages have been reported in a few articles as possibly associated with this medication, but the IRHs here are much less prominent than the ones reported (see below). STK was administered and neurologist was able to discontinue the Gilenya. 10 days later the CME had decreased significantly. 8 weeks later the edema had resolved as seen in the OCT images of the initial and latest appearance (the IRHs have decreased as well) Bhatti MT, Freedman SM, Mahmoud TH. Fingolimod therapy and macular haemorrhage. J Neuroophthalmol 2013; 33(4): 370–372. Ueda N, Saida K. Retinal haemorrhages following fingolimod treatment for multiple sclerosis; a case report. BMC Ophthalmol 2015; 15(1): 135.
Photographer: Kay Dalby
Imaging device: Topcon 50
Condition/keywords: cystoid macular edema (CME), Gilenya, macular edema
-
Fingolimob Associated Macular Edema (FAME)?
Jun 1 2019 by John S. King, MD
60 year old Caucasian female with two week history of decreased vision in the left eye. Background history includes multiple sclerosis for which she uses Gilenya for the past five years, and no history of uveitis or recent MS relapse. Her vision in the left eye was 20/100 J5. The eye appeared overall "quiet" with the exception of rare cells in the anterior vitreous. The fundus appearance and FA can be seen in the images provided. FA shows CME with scattered focal areas of vascular leakage (mainly venous) OS only. STK was administered and neurologist was able to discontinue the Gilenya. 10 days later the CME had decreased significantly. 8 weeks later the edema had resolved as seen in the OCT images of the initial and latest appearance.
Photographer: Kay Dalby
Imaging device: Optos CA
Condition/keywords: cystoid macular edema (CME), Gilenya, macular edema
-
Fingolimob Associated Macular Edema (FAME)?
Jun 1 2019 by John S. King, MD
60 year old caucasian female with two week history of decreased vision in the left eye. Background history includes multiple sclerosis for which she uses Gileyna for the past five years, and no history of uveitis or recent MS relapse. Her vision in the left eye was 20/100 J5. The eye appeared overall "quiet" with the exception of rare cells in the anterior vitreous. The fundus appearance and FA can be seen in the images provided. OCT shows CME and SRF in OS only (left image). STK was administered and neurologist was able to discontinue the Gileyna. STK has been reported to be effective in FAME in patients who continue Gileyna (see below). 10 days later the CME had decreased significantly. 8 weeks later the edema had resolved as seen in the OCT images of the initial and latest appearance. Of note, this is a late presentation for FAME, and there was some rare debris in the anterior vitreous; it is possible, although no history of uveitis and the MS was inactive, that the CME may be related to other causes like uveitis (if there is recurrence of CME while patient is off Gileyna, then further work-up will be performed) Minuk A, Belliveau MJ, Almeida DR, Dorrepaal SJ, Gale JS. Fingolimod-associated macular edema: resolution by sub-tenon injection of triamcinolone with continued fingolimod use. JAMA ophthalmol 2013; 131(6): 802–804.
Photographer: Kay Dalby
Imaging device: Cirrus
Condition/keywords: cystoid macular edema (CME), Gilenya, macular edema